Download Role of homoeopathic treatment in scabies infection in adivasi children

Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
EXTRA MURAL RESEARCH
Role of homoeopathic treatment in scabies infection in adivasi children attending
ashram shalas (resident schools)
1*
1
1
Chandrasekhar Goda , Prashant Tamboli , Sharmila Patil , Swarda Valimbe Kalyani Mhatre
1
1
Dr. M.L.Dhawale Memorial Trust, Mumbai, India
Scabies is a frequent skin disease suffered by of the tribal (adivasi) children attending residential
schools. The humid living conditions, crowding, poor personal hygiene, and inadequate nutritional
status of the children poses formidable challenges in the management of this disorder. Prolonged
allopathic treatment often fails to eradicate the infection in this unfortunate population. Infection and
other complications are common.
A prospective, randomized controlled, single blind study was carried out during the period November
2004 to December 2007 to explore the efficacy of homoeopathic treatment in tackling scabies infection
and controlling the spread.
300 cases were enrolled and divided into three treatment groups i.e. constitutional group, acute / sector
group and placebo group. Scabies infection was diagnosed by the dermatologist and graded as per the
severity of infection and children were observed for 2 years. All treatment groups were subjected to
standard hygienic measures during the course of the study.
Results were analyzed at the end of each year. 90% of the children from constitutional group improved
st
at the end of the 1 year whereas 27% from the acute and 4% from the placebo group improved. At the
end of the second year, the rate of improvement of the constitutional group rose to 98% whereas 48%
from the acute and 12% from placebo group improved. The prevalence of scabies in the school dropped
from 52% to 17% at a time when the prevalence of scabies in the residential schools in the area did not
show any reduction.
The results demonstrated statistically significant improvement in the constitutional group as compared
to the response in the acute and the placebo groups. It is concluded that the constitutional approach
holds great promise in the cure and control of treatment of infective skin conditions in a closed group.
The results also highlight the efficacy of homoeopathic medicines at a community level thus opening up
the vast untapped area of community medicine to homoeopathic interventions.
Keywords: scabies; constitutional treatment; randomized controlled study; homoeopathy; community
medicine
Introduction
It is extremely common in children and equally
affects both sexes. The incubation period is one
month. Once sensitization occurs, the time taken for
1
the subsequent infection is less. It spreads through
contact with infected individuals or infected clothes,
towels, bed linen, etc. It was observed that
prolonged contact especially during sleep is
2
responsible for the spreading of infection.
Scabies is an exceedingly common contagious disease
caused by the infestation of a mite- Acarus or
Sarcoptes Scabiei.1 It is also known as ‘seven year
itch’. It was very common during the First and the
Second World Wars but gradually has become rare in
most western countries. There has been a hypothesis
that scabies epidemics occur in a 30-year cycle. The
last cycle started in 1960 and ended in 1990.2 In India,
The most common symptom of scabies is itching
especially at night. It is more during warm and humid
climate.2 Initially, the itching is localized but gradually
becomes generalized. The common sites of infection
are webs of fingers, flexor aspect of wrist, elbow,
anterior axillary fold, upper thigh portion, buttocks and
genitalia. These sites usually get
the incidence in any Dermatology outpatient clinic varies
from 10 to 30% of all cases with a seasonal prevalence
2
and higher incidence in the winter months.
*Address for Correspondence:
Dr. Chandrasekhar Goda, Dr. M L. Dhawale Memorial Trust,
BMC's Mother and hild Holistic care Centre,
Harishankar Joshi Marg, Dahisar East, Mumbai 400068.
E-mail:[email protected]
33
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
Chandrasekhar Goda1*, et al
Materials and Methods
secondarily infected. Scalp, face, palms and soles
rarely get the secondary infection.
Randomized, placebo controlled, single blind study
was carried out during the period Nov. 2004 to Dec
2007, at the Dr. M. L. Dhawale Memorial Trust's
Community Health Centre, Bhopoli, Taluka
Vikramgarh, Dist. Thane. Dagadipada and Bhopoli
residential school of Vikramgrah taluka, Thane
district were selected for conducting the study. 315
children residing in the tribal schools between the
age groups 6 to 15 years having scabies were
enrolled for the study. The severity of the disease
differs from time to time. Hence, to quantify the
severity in a uniform way it was graded as shown in
the Table 1. This was done with the help of
dermatologist. There is no such ready classification
available in the textbooks of dermatology.
The children were randomly divided into 3
groups. The first group received constitutional
treatment, the second group received acute / sector
treatment and the third group which acted as a
control received placebo. Common hygienic
measures were maintained for all the three groups.
The baseline observations were taken after one
month of enrollment. In this first month, the hygienic
measures were standardized across all the groups.
They were observed over a 2 year period. Children
were observed for two years with the treatment. In
the third year the observations were recorded
without any treatment being administered to any of
the groups. However, the hygienic measures were
continued even in this period.
The diagnosis is established mainly from the
history and examination findings. Presence of a
burrow with a characteristic pattern of the lesions,
intense itching and history of similar complaints in
the past or in the family members are the cardinal
features of scabies.
From the homoeopathic angle, this state is
seen as a chronic and deep affliction needing the
use of deep-acting constitutional forces to correct
the underlying susceptibility thereby improving the
immunity to deal with the chronic infection. The
strategy for tackling the illness has been to use the
Constitutional remedy. Occasionally there is a need
of acute remedies to take care of severe superadded skin infections.
Aim
To explore and assess the role of homoeopathic
constitutional treatment in treating cases of Scabies
infection.
Objectives
1.
To assess the efficacy of homoeopathic treatment
in the prevention of recurrence of the infection.
2. To evolve a general strategy in managing this
common paediatric skin infection.
Table 1-Clinical criteria for grading of scabies
Clinical criteria
No. of sites
Itching
Eruptions
Grade 0
No Scabies
0
Absent
Absent
Grade 1
Mild
1 to 3
Mild
Less than 5
Follow up observations were done at weekly intervals.
Constitutional medicines were prescribed based on the
totality of symptoms. For prescribing acute / sector
medicines, only the characteristic features of local
signs and symptoms were considered. To begin with, a
single dose of constitutional medicine was prescribed
and the patient was observed until improvement
ceased. Then as per the state of susceptibility, the next
action was taken. To maintain the uniformity of doses
with other groups, placebo pills were given 4 times a
day on a regular basis. In case of acute medicines, the
indicated medicine was given 4
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
Grade 2
Moderate
4 to 7
Moderate
5 to 15
Grade 3
Severe
8 to 13
Severe
More than 15
times a day till the symptoms disappeared after
which placebo pills were given four times a day.
Placebo was given 4 times a day in the Placebo
group. The medicines used in the project were
manufactured by M/S Willmar Schwabe India Pvt.
Ltd. and obtained directly from the manufacturer.
Standard hygienic measures were followed for
all the three groups. Teachers, community health
volunteers, and class monitors recruited from the
senior classes, specially trained and motivated,
monitored this on a regular basis.
34
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
Chandrasekhar Goda1*, et al
Outcome assessment
4. Pace of the disease– Gradual / Rapid
The results were assessed by considering changes
in the grade of the infection. Concomitantly, changes
in other associated complaints were also noted. For
assessing the recurrence, yearly follow up was
considered. Peak seasons in which infection
exacerbates like rainy and winter were taken for
comparison.
5. Progress of the disease – Scabies always
present / Seasonal
Results
On the basis of the above the following three
categories were formulated:
High Susceptibility: Capacity of the individual to
throw up a good number of characteristics which
were readily expressed and perceived by the trained
observer. .
Moderate susceptibility: Individual throws up only a
moderate number of characteristics and the
expressions are mainly the common symptoms of
the disease.
Low Susceptibility: Poor capacity to throw up
characteristics. Even common symptoms like itching
are not expressed.
Out of the 315 registered children, 300 followed
hygiene regularly. These have been taken up for
analysis.
Efforts were made to understand the state of
susceptibility of the children. This was categorized
as low, moderate or high based on the following
parameters:
1. Predisposition – Family history of scabies
2. Qualified Mental Symptoms – Present / Absent
3. Character of expressions – Asymptomatic /
Symptomatic, if symptomatic then characteristic
/ common symptoms
6. Previous and current medications and its
response.
7. Other associated diseases
8. General vitality: Examination findings.
Table 2-State of susceptibility across the groups
Thus
by
Susceptibility
Constitutional
Acute
Placebo
Total
Low
11
08
08
27
Moderate
81
84
84
249
High
08
08
08
24
Total
100
100
100
300
understanding
the
susceptibility
one
understands how the person reacts to different stimuli.
this. Various aspects of posology like potency, dose
repetition are dependent on the level of susceptibility.
The characteristics expression and pathology guide in
35
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
1*
Chandrasekhar Goda , et al
Graph 1-Change in the susceptibility across the groups at the end of 2 years
Susceptibility After Treatment
95
100
90
80
70
60
50
40
65
43
34
24
30
23
20
10
0
4
11
1
Acute
Constitution
Improved
Placebo
Status Quo
Deteriorated
Graph 2-Grade wise changes in constitutional group after treatment
Changes in Constitutional Group
120
90
100
100
98
80
60
47
38
40
15
20
0
9 1
0
Before Rx.
2
0
1st Year
0
0
2nd Year
Grade 0 Grade 1
0
0
0
3rd Year
Grade 2 Grade 3
Graph 3-Grade wise changes in acute group after treatment
Changes in Acute Group
76
80
70
60
48
50
39
40
38
33
28
30
27
19
20
10
31
29
15
11
13
2
0
0
0
Before Rx.
1st Year
Grade 0
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
2nd Year
Grade 1
36
Grade 2 Grade 3
3rd Year
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
Chandrasekhar Goda1*, et al
Graph 4-Grade wise changes in placebo group after treatment
Changes in Placebo Group
50
45
40
35
30
25
20
15
10
5
0
45
39
35
39
36
34
28
28
26
26
21
20
12
7
4
0
Before Rx.
1st Year
Grade 0
2nd Year
Grade 1
3rd Year
Grade 2 Grade 3
Graphs 2, 3 & 4 clearly show that in the constitutional group, 90% of the
children improved within one year whereas 27% cases in the acute
group and 4% in the placebo group improved.
Graph 5-Rate of improvement across groups after the treatment
Rate of improvement across groups after Rx.
70
62
60
50
40
32
30
20
16
19
12
10
2
0
-10
13
9
0
4
3
3rd week
4th week
0
At Starting Rx.
1st week
Constitutional Group
Graph 5 shows the rate of commencement of
improvement across the groups. In the constitutional
st
group, the response was immediate i.e. from the 1
week itself. 62 children had shown improvement by
st
the end of the 1 week whereas 16% of cases
nd
started improvement from the 2 week.
2nd week
Acute Group
Placebo Group
In the acute group, 32% showed changes
within the first week. Then from the subsequent
weeks, rate of improvement was not linear. Placebo
group showed no change in the first week.
37
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
1*
Chandrasekhar Goda , et al
Table 3-Constitutional & Acute remedies prescribed
Constitutional
Remedies
Number of
Children
Acute Remedies
Number of
Children
Baryta carb.
03
Arsenic album
12
Calc. carb.
33
Calc. sulph.
08
Calc. phos
Calc. silicate
Kali. carb.
08
04
03
Graphites
Hepar sulph
Merc. sol.
09
25
42
Lycopodium
04
Pulsatilla
04
Nat. mur.
Nat. silicata
Sepia
14
03
02
Silicea
23
Sulphur
03
Total
100
Total
100
sector level. In such cases, sector / acute remedies are
indicated. This study also explored the role of acute
remedies in scabies treatment. 27% cases which were
treated through this approach were free of scabies at
the end of one year. Detailed analysis had shown that
where there was greater similarity, the response was
faster. Each remedy has a particular site affinity. This is
discussed in the later part.
Discussion
Efficacy of homoeopathic treatment
Theefficacy
of Homoeopathic treatment can
be established by comparing the results of the
different groups. The response is dependent on the
state of susceptibility and the changes brought about
in it through our medicines. The results are
compared in terms of
Hygiene is the most important part of the
treatment of the scabies. Placebo controls helped to
understand its importance. It also helped to verify the
results of homoeopathic treatment. At the end of the
one year, only 4% cases have improved in the placebo
group pointing out to the statistically significant results.
Results at the end i.e. presence or absence of
scabies
Rateof response to treatment
Recurrence of scabies
Results in all the three groups
Rate of response to the treatment
This study shows the efficacy of homoeopathic
medicines in the treatment of scabies infection.
Constitutional medicines are prescribed based on
the totality comprising of physical as well as mental
symptoms. Scabies, being a chronic disease, has
responded promptly to the constitutional approach.
90% cases improved at the end of one year of
treatment.
Efficacy of any treatment strategy is also dependent on
the rate of response. In a contagious infection like
scabies, a gradual response is expected when the
overall hygienic condition improves. If the response is
faster, it will not only lessen the suffering of that case
but will also reduce the risks of cross infection. The
improvement in the constitutional group is immediate.
62 % cases improved during the 1st week itself. In other
words, we can say that when the similimum is
prescribed, improvement should start within 2 weeks.
This will help in judging the remedy response. The
Acute group has shown a mixed pattern of response in
the rate of improvement. It also responded faster when
In some cases where the susceptibility is on the
lower side the characteristic constitutional symptoms
are not available. On the other hand, sometimes the
case presents with characteristics symptoms at the
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
38
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
Chandrasekhar Goda1*, et al
the scabies were present in the same area where
the remedy has affinity to that location. It is
important to note that none of the children from the
Placebo group improved in the first week.
Statistical analysis
Chi-Square test was applied to assess the statistical
significance of the results. The difference between
Constitutional group Vs Placebo group was p < 0.01
and that between the Constitutional group Vs. Acute
group was p < 0.01. The results of both these
groups are statistically significant. However, the
difference of the result between Acute group Vs.
Placebo group was not statistically significant.
Recurrence of scabies
Scabies is known to have seasonal fluctuations. It
becomes
dormant
during
unfavorable
circumstances. Therefore, results cannot be
confirmed until cases are observed over a
sufficiently prolonged period. The results of the
second year show the efficacy more clearly. There is
improvement in all the three groups. More cases as
compared to first year are becoming free of scabies
albeit at different rates across groups. At the same
time the severity of the infection is reducing across
the groups. In the constitutional group only 2%
children showed a recurrence and that too of a mild
variety. In the Acute group, 48% children improved
whereas 12% children were cured in Placebo group.
Observations carried out at the end of the third
year were without any treatment to any of the
groups. None of the children had scabies in the third
year from the constitutional group whereas 24%
children had recurrence from the acute group. Only
12% children were free of scabies in the third year in
the Placebo group. The severity of infection was less
in both Acute as well as Placebo group.
Collective community susceptibility
This project was carried out in a residential school. It
was a closed community. In a closed community there
is generally a balance struck between the agent, the
host and the environment. When this balance is
disturbed in an unfavorable manner, contagious
infections like scabies break open. In such instances
the chances of cross infections are very high. When
analyzing the responses at the individual and at the
group level we need to take into consideration the
overall load of scabies infection in that school.
When the project was started the prevalence of
scabies was 57%. At the end of one year of treatment,
it had come down to 32%. The prevalence further
reduced to 27 % at the end of the second year. The
interesting finding was at the end of the third year when
treatment had ceased the prevalence rate had dropped
to just 17%. That means there was a drastic reduction
in the scabies infection in the school.
Graph 6-Prevalence of scabies in the school over the period
Prevalence in the school
60
50
40
30
26
20
17
10
0
Before starting the
treatment
End of 1st year
End of 2nd year
End of 3rd year
Prevalence
39
Indian Journal of Research in Homoeopathy
Vol. 4, No. 2, April-June 2010
Role of homoeopathic treatment in scabies infection in adivasi children attending ashram shalas (resident schools)
Chandrasekhar Goda1*, et al
If we understand this response from the point of
susceptibility, which is the cornerstone concept in
Homoeopathy, we note that there was moderate
susceptibility in 83% of the cases at the
commencement of treatment. With treatment and
change brought about through hygienic measures
for three years, 65% of cases showed improvement
in their level of susceptibility. Therefore, there was
an overall change in all the groups. That means they
have collectively improved. In this study, since the
susceptibility of 65% cases had improved
individually the collective impact can be seen. These
observations suggest the presence of an entity like a
Collective Community Susceptibility.
Homoeopathic acute medicines to those
having low susceptibility.
d.
After acute treatment, completing the cure
the
constitutional
medicines
Acknowledgements
Authors thank Department of AYUSH for funding the
project. Authors also acknowledge the contribution
of Prof. Dr. C. Nayak, Director General, and Dr. Anil
Khurana, Asstt. Director, CCRH for close
supervision of the project. Authors are grateful to Dr.
Kumar Dhawale, Hon. Director, Dr. M L Dhawale
Memorial Organizations for support and technical
guidance in completing and conceptualizing the
project and the results.
References
1.
Stone S, Stephen P. Scabies. Fitzpatrick's
Dermatology in General Medicine. McGraw Hill
Medical, London, 2003: 2029.
2.
Valia R G, Valia A. Text Book of Dermatology, 3rd edition.
Bhalani Publishing House, Mumbai, 2002: 422.
1. Homoeopathic medicines are effective in the
management of Scabies.
2. Homoeopathic medicines prevent the recurrence
of Scabies.
3.
Gupta R, Manchanda R K. Text Book of Dermatology
st
for Homoeopathy, 1 edition. B Jain Pub. Ltd, New
Delhi, 2005: 98.
4. Allen H J. Diseases & Therapeutic of Skin. B Jain
Pub. Ltd, 1991: 186.
5. Skripkin Yu K, Mlich M V. Skin and Venereal
Diseases. MIR Publisher, Moscow, 1985: 229.
nd
6. Pasricha J S. Treatment of Skin Diseases, 2 edition.
Oxford & IBH Publishing Co., 1980: 84.
7. Markus R. Roxburgh's Common Skin Diseases.
ELBS, 1995: 54-55.
8. Dhawale M L. Concept of disease in Homoeopathy.
Principles & Practice of Homoeopathy. Institute of
Clinical Research, Mumbai, 1985:27.
9. Close Stuart. Susceptibility, Reaction & immunity. The
Genius of Homoeopathy. B Jain Pub. Ltd, 1986: 76.
10. Dhawale M L. Susceptibility. Principles & Practice of
Homoeopathy, Institute of Clinical Research. Mumbai,
1985: 357.
11. Close Stuart. Homoeopathic Posology. The Genius of
Homoeopathy. B Jain Pub. Ltd, 1986: 76.
12. Kent J T. Susceptibility. Lecture on Homoeopathic
Philosophy.B Jain Pub. Ltd, 1986: 122.
3. Constitutional approach is useful in curing
scabies infections in the paediatric age group. It
is also far more effective in preventing
recurrences in scabies than the acute approach.
4. Improvement starts within a week of the
administration of the constitutional medicines.
5. Repetition of acute medicine, four times a day,
has been the most useful posology practice.
6. Homoeopathic medicines act as a preventive
medicines.
7. There is possibly a greater role for
Homoeopathy as a Community medicine and
research studies need to be specially designed
to delineate this role.
8. Overall strategy of managing scabies with
homoeopathic mode of treatment can be laid
down as follows:
Institute and maintain adequate hygienic
standards as general measure.
Indian Journal of Research in Homoeopathy
c.
administering the indicated constitutional
medicine.
Conclusions
Vol. 4, No. 2, April-June 2010
Homoeopathic constitutional medicines to all
scabies affected cases where susceptibility
was in moderate zone. Cases having low
susceptibility and having severe secondary
infections do not respond to this mode of
treatment.
with
This brings out a different perspective in the
homeopathic management of infective conditions in
a closed community i.e. Role of Homoeopathic
medicines in the area of Community Medicine.
Homoeopathic treatment not only helps the patient
who is under treatment but it also prevents others
not under treatment from being infected. This aspect
of the preventive action of Homoeopathic medicines
as a Community Medicine needs to be verified by
further research work.
a.
b.
40
PDF to Word